Original Research

HIV-1 RNA testing of pooled dried blood spots is feasible to diagnose acute HIV infection in resource limited settings

Wentzel Dowling, Kirsten Veldsman, Mary G. Katusiime, Jean Maritz, Peter Bock, Sue-Ann Meehan, Marije Van Schalkwyk, Mark F. Cotton, Wolfgang Preiser, Gert U. Van Zyl
Southern African Journal of Infectious Diseases | Vol 33, No 2 | a6 | DOI: https://doi.org/10.4102/sajid.v33i2.6 | © 2019 Wentzel Dowling | This work is licensed under CC Attribution 4.0
Submitted: 07 May 2019 | Published: 29 June 2018

About the author(s)

Wentzel Dowling, Division of Medical Virology, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Business Unit, Cape Town, South Africa
Kirsten Veldsman, Division of Medical Virology, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Business Unit, Cape Town, South Africa
Mary G. Katusiime, Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
Jean Maritz, Division of Medical Virology, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Business Unit, Cape Town, South Africa
Peter Bock, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
Sue-Ann Meehan, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
Marije Van Schalkwyk, Division of Infectious Diseases, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa; Family Clinical Research Unit, Stellenbosch University, Cape Town, South Africa
Mark F. Cotton, Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Children’s Hospital, Cape Town, South Africa; Family Clinical Research Unit, Stellenbosch University, Cape Town, South Africa
Wolfgang Preiser, Division of Medical Virology, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Business Unit, Cape Town, South Africa
Gert U. Van Zyl, Division of Medical Virology, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Business Unit, Cape Town

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Abstract

Objectives:Rapid human immunodeficiency virus (HIV) antibody tests, routinely used for diagnosis in adults and older children in resource-limited settings (RLS), do not detect early HIV infections prior to seroconversion or when antibody levels are still low. Nucleic acid amplification to detect HIV-1 RNA is the most sensitive method for acute HIV infection diagnosis, but is costly. We therefore investigated HIV- 1 RNA testing of pooled dried blood spots (DBS) to diagnose acute HIV infection.

Design:Laboratory-based investigation.

Methods:DBS were collected from HIV-1 Voluntary Counselling and Testing (HVCT) clients who tested negative on the Advanced QualityTM HIV antibody rapid test. DBS samples from five participants were pooled and tested on the COBAS AmpliPrep/COBAS TaqMan HIV-1 (CAP/CTM) Test v2. Individual DBS were tested when pools tested positive (> 200 RNA copies/ml). Acute infection was confirmed by HIV viral load testing, two fourth-generation HIV serological assays, and Geenius™ HIV 1/2 Assay for antibody band identification.

Results:Of 482 participants who were tested, one (0.2%) had acute. HIV infection: Fourth generation serology was low-level positive, the plasma HIV viral load was 15 929 HIV-1 RNA copies/ml, gp160 and gp41 antibody bands were positive and the p31 band was negative, indicating a Fiebig Stage 5 infection.

Conclusions: Pooled DBS HIV-1 RNA testing is efficient compared to individual testing for acute HIV infection diagnosis. Early identification of participants with acute HIV infection facilitates immediate initiation of antiretroviral therapy to improve immune recovery and prevent transmission to others.


Keywords

Dried blood spot testing; HIV; HIV-1 RNA; South Africa

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